|Year : 2000 | Volume
| Issue : 4 | Page : 260-1
Medical ethics - Some thoughts
P N Nagpal
Source of Support: None, Conflict of Interest: None
Keywords: Ethics, Medical, Humans, India, Physician-Patient Relations, Questionnaires, Retrospective Studies,
|How to cite this article:|
Nagpal P N. Medical ethics - Some thoughts. Indian J Ophthalmol 2000;48:260
A nationwide survey in the United States in 1997 found that the medical profession is rated the most prestigious profession by 51% of the people, but this was 9% less than similar poll in 1997 an indication that the glass has dulled considerably. The situation in India is not very different.
Several recent articles in media have ridiculed professionals for greed and neglect. This fall in prestige of this so-called "noble profession" needs to be explored and investigated. A surge in negligence suits and lax regulations have undermined the credibility of the profession. Are we lacking ethics in this profession? Are we getting more commercial and businesslike? Are we playing with the "Hippocratic Oath"? There is a need to introspect and apply self-restraint. The saying "Physician heal thyself" should be taken more seriously.
"Ethics" (the "Science of morals") is mandatory for every profession, every business and in fact for the smooth running of every creation. In the medical profession ethics assume crucial importance since doctors deal directly with human life. The "nobility" of the profession is related to this aspect.
During discussions on medical ethics I have often asked participants, "What is the most precious possession of a person?" and received various answers including moral character, money, family etc. But in my opinion the most precious possession of a person is one's own body. Thirty thousand people may die in a Turkish earthquake. Four hundred persons may die in a train accident somewhere. The news is read, receives momentary attention and gets forgotten after some lip sympathy. But the ache in one's own tooth or back or neck and bothers one the most and gets priority. At this point the suffering individual seeks the help of the doctor, even saying, "You are God", and asks for relief from his distress. "You", the medical person now looked upon as God, can take full advantage of the situation-monetary or otherwise.
In the words of George Bernard Shaw the doctor is "Trusted to cure, privileged to kill, licenced to murder". You have that much potential. You know it. But should we take advantage of this situation? We medical professionals must differ from other professions for here something more than a commodity is involved. In this profession the patient pays the fee for treatment and still bends down, folds his hands, and says thank you. He does not do that to a shopkeeper. Allow me to discuss a different philosophy of life. Lets take the difference between Scientist and Godman: the former sees many in one and the later sees one in many.
The medical professional with a scientific attitude, sees everything as separate entities. He is in the habit of dividing, defining extents, and classifying. He forgets the Godly reality that everything in its togetherness is one and belongs to a single "Universe". The patient who sits across the table or is lying the couch belongs to the same "one" to whom we all belong and is actually an extension of ourselves. It is like a leaf of a tree telling the other one that "you are you, I am I and we are separate". And the tree is laughing over them.
We as medical persons are all familiar with such thoughts. We do not like to distinguish between a friend or foe during treatment. We not only treat but are also concerned for our patient. While one of our hands wears a glove for surgery, the other rises to pray for the patient. We always remember the saying, "I treat and He cures".
Many ophthalmologists admit we are more careful treating or operating a patient when he is one eyed. This does not imply that we are less careful in two-eyed patients. This imperceptible difference reflects our concern and compassion, and this distinguishes us from the other professions. The qualities of compassion and caring can set a doctor apart and distinguish him. I am reminded of the elderly lady with age-related macular degeneration who after visiting many senior ophthalmologists finally settled for treatment with a relatively new and young physician. When asked about her decision, she said, "Because he cried when he told me he could not save my eyesight".
Then why are we as medical professionals losing our prestige in the eyes of the public? What is eroding our credibility? Martin Luther King Jr. said, "Our Scientific power has outrun spiritual power. We have guided missiles but misguided men".
Fiscal forces play a pivotal role in one's life. Dependence on technology and machinery is another factor influencing our ethics. In the company of our costly machines we become machine-like. Our high investment in such machines, with its attendant obligations to bankers compels us to change our attitude to the patient sitting across the table from us.
Our forefathers had considered of these possibilities, hence the ethical codes were created and oaths prescribed. "Ethics" as a subject has no definition and no discipline. Deviation from the standard can only be understood if the standard is well defined. A man sitting on the railway station, tried and annoyed of waiting for the late running train went into the station master's room and thumped the Railway time table on his table and demanded -"Why do you print this if the trains run so late". The station master very calmly replied "Otherwise how will you know how late the train is".
"Ethics" tend to vary across time, place, and culture. As new disciplines come up and our environment changes, adjustments have to be made. For instance, advertising was shunned by most medical professionals in the past for it was thought that the patients in their despair cannot be expected to properly interpret the advertised medical service. But today it is an accepted mode of providing information to the patient.
Medical education today increasingly deals with technology and is thus eroding the traditional doctor-patient relationship, resulting in growing distrust. Providing appropriate cost-effective care with compassion and competence is the right path to restore the lost prestige of this profession. Thus, the four "Cs" of a good doctor must always be kept in mind: Competence, Cost effectiveness, Convenience and Caring.
I like Nelson Jackson, do not believe that one "can do today's job with yesterday's methods and still be in business tomorrow". Change is inevitable. While there is no denying the need and importance of keeping up with the latest technology decretion must be used while adapting to it. One has to differentiate between the fashionable acquisition and lucrative investment - one must ask if it is going to further the cause of science.
Group practice has been adapted successfully in the West and in several places in our country. Colossal investments are required to put up even a basic eye care clinic. Therefore it seems like a good solution to share this economic burden, rather than continually agonize about finances or adopt measures that can tarnish our profession. A colleague need not be a competitor, we could develop a symbiotic relationship and in the process the patient benefits the most.
Why study ethics? And more important can ethical behaviors be taught? Many would argue that ethical behavior cannot be learnt. But I feel it can be taught and learnt much as we learn to behave appropriately among family, friends and schoolmates. We discover what is acceptable and what is not, what is correct and what is not.
Another aspect adversely affecting the health of our profession is the criticism aimed at colleagues. It creates very embarrassing situations. Source and does nothing to further the cause of medicine. In our profession the "ethical practice" is decided by one and only thing "the Good of the patient and the community".
| References|| |
Harris Poll 1997. Cited in Eye Net.
San Francisco: American Academy of Opthalmology, 1997.